Dr. James Fedich Membership Application Form

Please fill out the form below to apply for a membership plan, *are required fields.


Applicant Information:

Today's Date:

Membership Options:

Silver

$250/Month

Comes with
E-mail

Choose Plan

Gold

$350/Month

Comes with
E-Mail and Phone

Choose Plan

Platinum

$750/Month

Comes with both
E-mail, Phone, PLUS 2 Days in
Dr. Fedich's clinic a year!

Choose Plan

Included in All Three levels is access to Dr. Fedich's archives. All the documents, ads, and training he uses to build his practice. These are updated monthly as more are added!

Documents included:

  • Full Copy of his best selling book
  • Financial Plan Calculator
  • Checklists for office staff
  • Application Form
  • Disc Pain Ads
  • Other ads
  • Press release examples
  • New Patient Welcome Letter
  • Stats Training
  • Internet marketing Presentation powerpoint
  • Recall Letters
  • Recalls Scripts,
  • And much more, and more added monthly!

Video Training: Learn directly from Dr. Fedich, anytime and anywhere!

  • Full Day 1 Training
  • Full Day 2 Training
  • Myovision Training
  • Posture screen Training
  • Front desk phone training
  • Handling objections
  • Re-evaluation procedures
  • Full Million Dollar clinic traning, spend over 3 hours in Dr. Fedich's office while he teaches you his systems!

Please answer the following questions below:

1. Current gross income:*
Below $200,000 $200 - $400,000 $400 - $600,000 $600 - $800,000 Over $800,000

2. How many patient visits a week do you see?*
0 - 50 51 - 100 101 - 150 151 - 200 201 - 250 Over 250

3. How many new patients per month do you see?*
0 - 50 51 - 100 101 - 150 151 - 200 201 - 250 Over 250

4. What are your collection goals in the next 24 months?*
Below $400,000 $400 - $600,000 $600 - $800,000 $800,000 - $1 million $1 million - $1.2 million Over $1.2 million